ABSTRACT By 2030, adults older than 65 years will exceed 20% of the U.S. population. In parallel to this rapidly-changing demographic, rates of surgery in this population are expected to increase by as much as 30%. Although substantial efforts have been made to reduce perioperative complications and mortality, far less attention has been aimed at the long-term implications of surgery in older adults. In such patients, functional and cognitive decline are common, and may persist or progress to permanent disability or dementia and even death. An in-depth understanding of these long-term implications will shed light on how and when to introduce palliative care strategies to such patients. Capitalizing on rich and longitudinal data from the Health and Retirement Study (HRS) linked to Medicare data, we will conduct a mixed methods evaluation of the clinical, functional, cognitive, and economic outcomes in older adult patients who suffer a serious complication following high-risk elective surgery (Aim 1). More than 27,000 individuals have participated in HRS since its inception in 1992, which details specific information on sociodemographics, health status, spending and utilization, and functional and cognitive status. Through the unique and robust collaborative infrastructure of surgical programs in the State of Michigan, we will then perform a qualitative analysis of surgeon-perceived barriers to use of palliative care services directly informed by our findings from the HRS analysis (Aim 2). This study will have immediate impact on local and national initiatives by revealing how surgeons and hospitals can better anticipate and manage older adult patients' needs who may undergo high-risk surgical procedures. Furthermore, results from this study will allow for the design and implementation of a computer-based, empirically-driven alert to screen for and prompt palliative care referrals in older adult patients who may undergo high-risk surgery. This proposal is the ideal mechanism for me to transition my research career to a focus on palliative care and aging. Successful completion of this project will promote my application for externally-funded career development awards such as the Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76) and a subsequent R01. The project, mentorship, and educational plan will prepare me to be an independent investigator and national leader in palliative care and aging among surgical populations.